Why are public health people excited about a handful of measles cases?

Right now there’s an outbreak in Arizona. As of the moment I’m writing these words, outbreak in this instance means 11 cases. Doesn’t sound like a big deal.

But, there are reasons for concern.

To put some perspective on this, prior to 1980, before most kids were getting immunized against measles, infection caused 2.6 million deaths each year.

Measles is wildly contagious. Let’s say I’m infected with measles—I pop into the local Walmart’s restroom, do my thing, wash my hands, and cough before I go out the door. Everyone who enters that restroom for the next two hours will be exposed to the virus, which is hanging in the air and also waiting on the countertops, taps, and doorknob.

Just walk into the restroom and you’re exposed. It’s that easy to pick up.

Protection comes through immunization, although there are some who have been immunized who will still become infected. No vaccine protects 100% of the people 100% of the time.

We were writing an update on EV-D68 when this email arrived from CDC. We think the points are important for parents to know, so we’re going to share this with you and will provide future updates as warranted.

As parents, we’re all concerned about this virus which isn’t really new, but has captured the nation’s attention. If you have questions, please ask them in the comments and we’ll get answers for you.

[This information is current as of 23 October, 2014 and has been slightly edited for length (believe it or not). The bold text includes the latest updates]:

The United States is currently experiencing a nationwide outbreak of enterovirus D68 (EV-D68) associated with severe respiratory illness.

From mid-August to October 23, 2014, CDC or state public health laboratories have confirmed a total of 973* people in 47 states and the District of Columbia with respiratory illness caused by EV-D68.** This indicates that at least one case has been detected in each of those states but does not indicate how widespread infections are in each state.

In the United States, people are more likely to get infected with enteroviruses in the summer and fall. We are currently in the middle of the enterovirus season. EV-D68 infections are likely to decline later in fall.

For the week of October 8-12, 34 states reported to CDC that EV-D68-like illness activity is low or declining; 8 still have elevated activity, and only 1 has increasing activity.

Many state health departments are currently investigating reported increases in cases of severe respiratory illness in children. This increase could be caused by many different viruses that are common during this time of year. EV-D68 appears to be the predominant type of enterovirus this year and is likely contributing to the increases in severe respiratory illnesses.

Due to increasing knowledge about the nationwide EV-D68 outbreak, there has been a very large increase in the number of specimens tested from patients with severe respiratory illness. Awareness of these initial results is also contributing to increased recognition of new cases.

CDC is prioritizing testing of specimens from children with severe respiratory illness. There are likely many children affected with milder forms of illness.

Of the more than 1,700 specimens tested by the CDC lab, about half have tested positive for EV-D68. About one third have tested positive for an enterovirus or rhinovirus other than EV-D68. Almost all of the CDC-confirmed cases this year of EV-D68 infection have been among children. Many of the children had asthma or a history of wheezing.

CDC has developed, and started using on October 14, a new, faster lab test for detecting EV-D68, allowing CDC to rapidly process in about seven to 10 days the more than 1,000 remaining specimens received since mid-September. As a result, the number of confirmed EV-D68 cases will likely increase substantially in the coming days. These increases will not reflect changes in real time or mean the situation is getting worse.

As a result, confirmed cases increased today and will likely continue to increase in coming days. This does not mean the situation is getting worse.

Faster testing will help to better show the trends of this outbreak since August and to monitor changes occurring in real time.

EV-D68 has been detected in specimens from eight*** patients who died and had samples submitted for testing.

CDC is reporting the test results to state health departments as we obtain them. State and local officials have the authority to determine the cause of death, the appropriate information to release, and the time to release it. CDC will defer to states to provide this information.

So far, state and local officials have reported that two of these deaths were caused by EV-D68.

CDC will post updated data to the website every Thursday.

CDC understands that Americans may be concerned about these severe respiratory illnesses and the new reports of neurological illness. Severe illness is always a concern to us, especially when infants and children are affected. We will share information as soon as we have it, and post updates on our website (http://www.cdc.gov/non-polio-enterovirus/outbreaks/EV-D68-outbreaks.html).

Clinicians should consider EV-D68 as a possible cause of severe respiratory illness, particularly in children, and report unusual increases in the number of patients with severe respiratory illness to their health department.

The general public can help protect themselves from respiratory illnesses by washing hands with soap and water, avoiding close contact with sick people, and disinfecting frequently touched surfaces. Anyone with respiratory illness should contact their doctor if they are having difficulty breathing, or if their symptoms are getting worse.

*Total confirmed case count includes results from State Public Health Laboratories that can do testing to determine type of enterovirus.
**The primary reason for current increases in cases is that a backlog of specimens is being processed from several states that are investigating clusters of people with severe respiratory illness. It can take a while to test specimens and obtain lab results because the testing is complex and slow, and can only be done by CDC and a small number of state public health laboratories. These increases will not necessarily reflect changes in real time, or mean that the situation is getting worse.
***Investigations are ongoing; CDC will review and update available data every Wednesday.

BACKGROUND

Enteroviruses are very common viruses; there are more than 100 types.

It is estimated that 10 to 15 million enterovirus infections occur in the United States each year. Tens of thousands of people are hospitalized each year for illnesses caused by enteroviruses.

Different enteroviruses can cause different illnesses, such as respiratory, febrile rash, and neurologic [e.g., aseptic meningitis (swelling of the tissue covering the brain and spinal cord) and encephalitis (swelling of the brain)].

In general, the spread of enteroviruses is often quite unpredictable. A mix of enteroviruses circulates every year, and different types of enteroviruses can be common in different years.

In the United States, people are more likely to get infected with enteroviruses in the summer and fall.

Enterovirus D68

EV-D68 was first recognized in California in 1962. Small numbers of EV-D68 have been reported regularly to CDC since 1987. However, this year the number of people with confirmed EV-D68 infections is much greater than that reported in previous years.

The strains of EV-D68 circulating this year are not new.

CDC, working with state health departments, has identified at least three separate strains of EV-D68 that are causing infections in the United States this year; the most prominent strain is related to the strains of EV-D68 that were detected in the United States in 2012 and 2013.

There is no evidence that unaccompanied children brought EV-D68 to the United States; we are not aware of any of these children testing positive for the virus.

It is common for multiple strains of the same enterovirus type to be co-circulating in the same year.

Respiratory illnesses can be caused by many different viruses and have similar symptoms. Not all respiratory illnesses occurring now are due to EV-D68.

EV-D68 has been previously referred to as human enterovirus 68 (or HEV-68) and human rhinovirus 87 (or HRV-87). They are all the same virus. The D stands for enterovirus species D.

SYMPTOMS

EV-D68 infections can cause mild to severe respiratory illness, or no symptoms at all.

Severe symptoms may include wheezing and difficulty breathing.
Anyone with respiratory illness should contact their doctor if they are having difficulty breathing, or if their symptoms are getting worse.

Enteroviruses are known to be one of the causes of acute neurologic disease in children. They most commonly cause aseptic meningitis, less commonly encephalitis, and rarely, acute myelitis and paralysis.

CDC is aware of two published reports of children with neurologic illnesses confirmed as EV-D68 infection from cerebrospinal fluid (CSF) testing.

PEOPLE AT RISK

In general, infants, children, and teenagers are most likely to get infected with enteroviruses and become sick. That’s because they do not yet have immunity (protection) from previous exposures to these viruses. We believe this is also true for EV-D68. Adults can get infected with enteroviruses, but they are more likely to have no symptoms or mild symptoms.

Children with asthma may have a higher risk for severe respiratory illness caused by EV-D68 infection.

TRANSMISSION

Since EV-D68 causes respiratory illness, the virus can be found in an infected person’s respiratory secretions, such as saliva, nasal mucus, or sputum.

The virus likely spreads from person to person when an infected person coughs, sneezes, or touches a surface that is then touched by others.

Diagnosis

EV-D68 can only be diagnosed by doing specific lab tests on specimens from a person’s nose and throat.

Many hospitals and some doctor’s offices can test sick patients to see if they have enterovirus infection. However, most cannot do specific testing to determine the type of enterovirus, like EV-D68. CDC and some state health departments can do this sort of testing.

CDC recommends that clinicians only consider EV-D68 testing for patients with severe respiratory illness and when the cause is unclear.

TREATMENT

There is no specific treatment for people with respiratory illness caused by EV-D68 infection.

For mild respiratory illness, you can help relieve symptoms by taking over-the-counter medications for pain and fever. Aspirin should not be given to children.

Some people with severe respiratory illness caused by EV-D68 may need to be hospitalized and receive intensive supportive therapy.

There are no antiviral medications are currently available for people who become infected with EV-D68.

PREVENTION

You can help protect yourself from getting and spreading EV-D68 by following these steps:

Wash hands often with soap and water for 20 seconds

Avoid touching eyes, nose and mouth with unwashed hands

Avoid close contact such as kissing, hugging, and sharing cups or eating utensils with people who are sick, or when you are sick

Cover your coughs and sneezes with a tissue or shirt sleeve, not your hands

Clean and disinfect frequently touched surfaces, such as toys and doorknobs, especially if someone is sick

Stay home when you are sick

There are no vaccines for preventing EV-D68 infections.

Children with asthma are at risk for severe symptoms from EV-D68 and other respiratory illnesses. They should follow CDC’s guidance to maintain control of their illness during this time:

Take your prescribed asthma medications as directed, especially long term control medication(s).

Be sure to keep your reliever medication with you.

Get a flu vaccine when available.

If you develop new or worsening asthma symptoms, follow the steps of your asthma action plan. If your symptoms do not go away, call your doctor right away.

Parents should make sure the child’s caregiver and/or teacher is aware of his/her condition, and that they know how to help if the child experiences any symptoms related to asthma.

WHAT IS CDC DOING

CDC continues to collect information from states and assess the situation to better understand EV-D68 and the illness caused by this virus and how widespread EV-D68 infections may be within states and the populations affected.

CDC is helping states with diagnostic and molecular typing for EV-D68.

We are working with state and local health departments and clinical and state laboratories to enhance their capacity to identify and investigate outbreaks, and perform diagnostic and molecular typing tests to improve detection of enteroviruses and enhance surveillance.

CDC has developed, and started using on October 14, a new, faster lab test for detecting EV-D68 in specimens from people in the United States with respiratory illness. CDC will provide protocols to state public health labs and explore options for providing test kits.

CDC’s new lab test is a “real-time” reverse transcription polymerase chain reaction, or rRT-PCR, and it identifies all strains of EV-D68 that we have been seeing this summer and fall. The new test has fewer and shorter steps than the test that CDC and some states were using previously during this EV-D68 outbreak. This will allow CDC to test and report results for new specimens within a few days of receiving them.

The previous test, which CDC used for about nine years, is very sensitive and can be used to detect and identify almost all enteroviruses; however, it requires multiple, labor-intensive processing steps and cannot be easily scaled up to support testing of large numbers of specimens in real time that is needed for the current EV-D68 outbreak.

We are providing information to healthcare professionals, policymakers, general public, and partners in numerous formats, including Morbidity and Mortality Weekly Reports (MMWRs), health alerts, websites, social media, podcasts, infographics, and presentations.

CDC has obtained one complete genomic sequence and six partial genomic sequences from viruses, representing the three known strains of EV-D68 that are causing infection at this time.

Comparison of these sequences to sequences from previous years shows they are genetically related to strains of EV-D68 that were detected in previous years in the United States, Europe, and Asia.

CDC has submitted the sequences to GenBank to make them available to the scientific community for further testing and analysis.

GUIDANCE FOR CLINICIANS

Clinicians should:

consider EV-D68 as a possible cause of acute, unexplained severe respiratory illness, even if the patient does not have fever.

report suspected clusters of severe respiratory illness to local and state health departments. EV-D68 is not nationally notifiable, but state and local health departments may have additional guidance on reporting.

consider laboratory testing of respiratory specimens for enteroviruses when the cause of respiratory illness in severely ill patients is unclear.

consider testing to confirm the presence of EV-D68. State health departments can be approached for diagnostic and molecular typing for enteroviruses.

contact your state or local health department before sending specimens for diagnostic and molecular typing.

follow standard, contact, and droplet infection control measures

The antiviral drugs pleconaril, pocapavir, and vapendavir, have significant activity against a wide range of enteroviruses and rhinoviruses. CDC has tested these drugs for activity against currently circulating strains of enterovirus D68 (EV-D68), and none of them has activity against EV-D68 at clinically relevant concentrations.

SURVEILLANCE

U.S. healthcare professionals are not required to report known or suspected cases of EV-D68 infection to health departments because it is not a nationally notifiable disease in the United States. Also, CDC does not have a surveillance system that specifically collects information on EV-D68 infections.

No data is currently available regarding the overall burden of morbidity or mortality from EV-D68 in the United States. Any data CDC receives about EV-D68 infections or outbreaks are voluntarily provided by labs to CDC’s National Enterovirus Surveillance System (NESS). NESS collects limited data, focusing on circulating types of enteroviruses and parechoviruses.

I remember lining up at school in the ‘60s to get vaccinated against smallpox and a few other diseases for which there were vaccines.

I also remember the years when my brothers and I took turns at getting measles, mumps and other diseases for which there were no vaccines.

In the end, we three were fortunate—no permanent harm from our maladies.

Fast-forward 30 years. My daughter was four months old when she was diagnosed with hepatitis B. She had not been vaccinated and subsequently developed a chronic infection.

It all sounds mundane when read as words on a screen. But in those early years, the heartache and anger I felt at having my daughter’s life so affected by something that was preventable . . . well, it was almost more than I could bear.

But again, we were fortunate. After years of infection, her body turned around and got control of the disease. Although we have bloodwork done every year to keep an eye on things, she has a good chance of living the rest of her life free of complications from this infection.

Over the years, I’ve met other parents whose children were affected by vaccine-preventable diseases. Some, like Kelly and Shannon, chose not to vaccinate their kids and ended up with horrible consequences. Kelly’s son Matthew was hospitalized for Hib and they came within a breath of losing him. Shannon did lose her daughter Abigale to pneumococcal disease, and almost lost her son. He recovered and was released from the hospital, at which time they had a funeral for their daughter.

Because of my job, I talk to and hear from many families with similar stories. Some children have died, some remain permanently affected, and some have managed to recover.

Also because of my job, I hear from parents who believe vaccines are not safe, and that natural infections are the safer choice. I understand and have experienced the emotions we as parents feel when something happens to our children. In a way, I was lucky. I knew exactly what caused my daughter’s problems. A simple test provided a definite diagnosis.

If we can’t identify the cause of our children’s pain or suffering, we feel like we can’t fix it and we can’t rest until we know the truth. When the cause can’t be found, we latch onto if onlys. What could we have done differently to keep our kids safe? If only we hadn’t taken her to grandpa’s when she didn’t feel good. If only we hadn’t vaccinated him on that particular day. If only. The problem is, the if onlys are guesses and no more reliable routes to the facts than playing Eenie Meenie Miney Mo.

The deeper I go into the world of infections and disease prevention, the more obvious it is to me that the only way to find the facts is to follow the science. Now granted, one study will pop up that refutes another, but I’ve learned that when multiple, replicable studies all reach the same conclusion, then I can safely say I’ve found the facts.

In our family, we vaccinate because for us, it is the thoughtful choice.

It’s tick season! The CDC says that from May through July is the high season for tick bites and tickborne diseases.

Nearly 30,000 cases of Lyme disease are reported to the CDC each year, yet about 20 percent of people in areas where Lyme disease is common are unaware that it’s a risk. And, even in those areas where the disease is common, 42 percent of individuals report taking no preventive measures against ticks.

If you’re wondering about your risk, this is where 95 percent of Lyme disease cases occur in the US:

Connecticut

Delaware

Maine

Maryland

Massachusetts

Minnesota

New Hampshire

New Jersey

New York

Pennsylvania

Virginia

Wisconsin

Other tickborne diseases include Rocky Mountain spotted fever, anaplasmosis, ehrlichiosis, and babesiosis. These diseases tend to be concentrated in specific parts of the country. Check with your county health department to see what the risks are in your area.

Diseases reported to CDC by state health departments. Each dot represents one case. The county where the disease was diagnosed is not necessarily the county where the disease was acquired.

Tickborne diseases can cause mild symptoms to severe infections requiring hospitalization. The most common symptoms of tick-related illnesses can include fever/chills, aches and pains, and rash. Early recognition and treatment of the infection decreases the risk of serious complications, so see your doctor immediately if you have been bitten by a tick and experience any of these symptoms.

Stay on top of prevention by following these CDC recommendations:

Avoid areas with high grass and leaf litter and walk in the center of trails when hiking.

Use repellent that contains 20 percent or more DEET on exposed skin for protection that lasts several hours. Parents should apply repellent to children; the American Academy of Pediatrics recommends products with up to 30 percent DEET for kids. Always follow product instructions.

Use products that contain permethrin to treat clothing and gear, such as boots, pants, socks and tents or look for clothing pre-treated with permethrin.

Treat dogs for ticks. Dogs are very susceptible to tick bites and to some tickborne diseases, and may also bring ticks into your home. Tick collars, sprays, shampoos, or monthly “top spot” medications help protect against ticks.

Bathe or shower as soon as possible after coming indoors to wash off and more easily find crawling ticks before they bite you.

Conduct a full-body tick check using a hand-held or full-length mirror to view all parts of your body upon returning from tick-infested areas. Parents should help children check thoroughly for ticks. Remove any ticks right away.

Do you remember SARS (Severe Acute Respiratory Syndrome)? It popped up in China in 2002 and spread to more than 25 countries before we could blink.

PKIDs landed a group of disease prevention educators in China just as the world became aware of this outbreak that would rapidly become an epidemic. It was coincidence, of course. The trip had been planned for months.

But, our proximity to the SARS outbreak was a reminder to us of how efficient air travel is at spreading germs.

In 2009, there were 2.5 billion airline passengers and that number is expected to increase to 3.3 billion by 2014. That’s a lot of sneezing, coughing, and just plain touching of armrests, overheads, and other surfaces going on in small spaces.

Dr. Alexandra Mangili and Dr. Mark Gendreau wrote a piece for the Lancet in 2005 that talks about the mechanics of disease transmission in an airplane. It’s very good, if you have a few minutes to read it.

They explain air flow patterns and how much air is recirculated (50% and that’s through filters). Turns out, air does not flow the length of the plane, but rather in sections or pockets along the width of the plane. Still an efficient method of disease transmission for airborne and large droplet transmission, but not the only way germs are spread onboard.

According to the article, the most common infections on aircraft have been via the fecal-oral route through contaminated food, although that has diminished in the last few years, possibly due to prepackaged food products and more care in the prepping and handling of food.

Mosquitos, a common vector for diseases such as dengue and malaria, often hitch rides on airplanes. Mangili and Gendreau point out that, “Many cases of malaria occurring in and around airports all over the world in people who had not travelled to endemic areas, known as airport malaria, is evidence that malaria-carrying mosquitoes can be imported on aircraft.”

The cabins of airplanes cannot be thoroughly disinfected between flights. Many times, a plane lands, passengers disembark, and more passengers are seated within 30 minutes. Think of all the droplets of goo left behind that the cleaning crew cannot remove, and the many surfaces that can’t be disinfected.

Keeping one’s hands clean throughout the flight will go a long way toward preventing transmission, and staying up-to-date on your vaccinations for your home country and your destination. As for masks, the authors say, “Although masks play a crucial part in infection control in health care settings, their use is unproven in disease control within the aircraft cabin.” But they do recommend masking and isolating someone suspected of having SARS.

Are you going to London for the Olympics? I lived in Calgary when the Games were held there. It’s chaos and fun and nothing like you’d expect, if you’ve never been.

You’ll meet people and germs from scores of countries—about 11 million people, to be specific, and each one teeming with his or her own microbes. Olympics health director Brian McCloskey says they’re ready to go and will be on the lookout primarily for GI bugs “and infectious diseases such as measles.”

Want to bring home souvenirs that won’t make you sick? Use this CDC piece as a checklist on staying healthy in London during the Olympics:

Be Up-to-Date on Your Jabs

Some illnesses that are very rare in the United States, such as measles, may be common in other countries. Make sure that you and any children traveling with you have had all shots. Even if you had all routine vaccines as a child, ask your doctor if you need a tetanus/diphtheria/pertussis booster.

Watch Out for that Lorry!

In the United States, you’re taught to look left, look right, and look left again before you cross the road. In England, however, they drive on the left side of the road. That means you should always look right, look left, and look right again to avoid stepping into the path of traffic driving on the left.

Get Thee to an A&E

If you get hit by a lorry, don’t call 911, call 999, and don’t ask to be taken to the ER, ask for the A&E (Accident and Emergency). Only call 999 in the event of a serious illness or injury. For cuts and scrapes, muscle strains, or minor illnesses, visit a pharmacy or walk-in center (no appointment needed). To find a pharmacy or walk-in center, visit www.nhs.uk/London2012 or call 0845-4647.

Note that the health insurance that covers you in the United States probably won’t cover you while you’re overseas, so you may have to pay out-of-pocket for any care you receive in London. Consider purchasing travel health insurance that will reimburse you for any costs you incur.

Go on Holiday (But Not from Healthy Habits)

Have a great time in London, and make sure you take your healthy habits with you:

Always wear a seatbelt.

Wash hands frequently, or use hand sanitizer.

Cough and sneeze into a tissue or your sleeve (not your hand).

When outdoors during the day, wear sunscreen, stay hydrated, and seek shade if you get too hot.

When indoors or at large events, know where emergency exits are.

If you drink alcohol, do so in moderation.

Use latex condoms, if you have sex.

Speak Like a Native

Some terms, including health-related terms, differ between British English and American English. Be familiar with these to avoid confusion if you need medical care.

At PKIDs, we talk a lot about disease prevention and the three steps you and your family can take to stay as healthy as possible. Today I’m going to share some of our information about one of those steps, but I can’t resist mentioning the other two.

Second, check with your provider to see what vaccines you and your family need and then get vaccinated on schedule.

Third, practice standard precautions in daily living. This means that you assume that everyone’s blood and body fluids are infectious for HIV, hepatitis B or C, or other bloodborne pathogens and you act accordingly.

People of all colors, rich and poor, fat and thin, old and young are chronically infected with HCV, HBV, HIV, and other diseases. Forty to 90 percent of these folks don’t know they’re infected.

It’s impossible to identify those living with an infectious disease. The only way to try and keep yourself and your kids reasonably healthy is to learn a practical approach to standard precautions. At first, you’ll be paranoid of everyone and everything, but as the precautions become habits, they’ll be a natural part of your life—like turning the lock on a door, or stepping on the brake at a red light. They will become normal, daily precautions.

The primary thing to remember with standard precautions is to always have a barrier between your skin and mucous membrane (around the eyeballs, gums, and inside the nose), and the (potentially) infectious substance. Go to a medical supply store and buy some latex gloves. Keep them in your house and car. If you don’t happen to have gloves and you need to deal with someone’s body fluid, put sandwich baggies or trash can liners over your hands. Use a sanitary napkin or thick, rolled-up towel to collect the fluid or staunch the flow of blood.

Sometimes blood and body fluids can become airborne. If you wear glasses, keep them on. If you don’t wear glasses, put on your sunglasses to protect your eyes. If you have one, tie a scarf around your face like the masked bandits used to do.

Use a one-part bleach to ten-part water solution or another disinfectant for cleaning up substances, including your own! As soon as you have dealt with the situation, throw away the disposable protective items (your gloves, etc.) and wash your hands thoroughly.

As soon as possible, cover your hands again and remove any non-disposable items you’re wearing and wash them appropriately. Common sense will guide you in this. Just don’t go through all of the precautions only to bare-hand your dress which is covered in someone else’s body fluid.

Make sure you keep all of your cuts and abrasions covered with a waterproof bandage. Be careful with badly chapped skin. It can crack and allow fluids to enter and exit. These precautions are a two-way street. You may be one of the millions unaware that you’re living with an infectious disease.

Only you know if your child is old enough to understand these precautions. Practicing them with your kids would be useful for the whole family. If your kids are too young to understand what we’ve outlined, there are a few things you can try to help the younger members of the family participate in standard precautions.

It would help if you set aside a non-work day to role play this with your kids. Call it: Family Safety Day. This would also be a good day to practice evacuating the house in case of fire and all those other safety rules we seldom rehearse.

To help the kids understand how invisible germs can pass from one person to the next, put glitter on your child’s hands and let him/her go to the bathroom, play with family members, and pick up a cracker (without actually eating it). Go back to the beginning of the journey and walk him/her around the house, following the trail of glitter. This will help demonstrate how we can pass germs (and other things) to each other without knowing it. To press home the point, you might put glitter on your hands, too.

Have one member of the family be “bleeding” ketchup. You be a young child and run for an adult when you see the blood. Have your young child go through the same scenario several times. Then pretend there’s no adult around and show your child how to use a coat or towel as a barrier between them and the blood.

It’s important that they learn not to reach out and touch another person’s blood or body fluid. One way to help them understand (and this is kind of gross) is to ask them if they would touch someone else’s poop or nose gunk. Most kids, no matter how young, will say no. You can then explain that blood is really personal, like poop and nose gunk, and they don’t want to touch anyone else’s blood.

This approach is necessary only for a few years. Once they get to be five or six, you can start explaining more.

A few general rules for everyone to remember would be: don’t share razors, toothbrushes, manicure tools, nail clippers, hypodermic needles, cocaine straws, body piercing equipment, tattooing equipment, or anything that can puncture or is a personal grooming item.

Standard precautions as practiced by healthcare professionals cover a wide range of topics, including sharps disposal, ventilation devices (mouth pieces for resuscitation), specimen handling, and other opportunities for the spread of infection which you are unlikely to come across in daily living.

We wanted to give you some practical, basic precautions to help you live a normal, safe life. Let us know if you have any ideas for teaching little ones precautions.

You might want to check on your daycare or preschool or kindergarten’s awareness of standard precautions. Most of them will say they’ve had AIDS training. If they are receptive to suggestions, feel free to share some of these ideas with them.

We know of a preschool which keeps a chart for cleaning the bathrooms, gloves are always worn when necessary, and they really work hard to do everything right. But, several of the preschoolers never get to use soap on their hands because the sink is too wide for them to reach across to the soap dispenser, and the side access is blocked from a large storage cabinet which is pushed against the sink. The best of intentions can’t overcome reality.

Following these steps won’t guarantee you a disease-free life, but it’ll cut down on the number of infections you have.

Disclaimer

The information on PKIDs' Blog is for educational purposes only and should not be considered to be medical advice. It is not meant to replace the advice of the physician who cares for you or your child. All medical advice and information should be considered to be incomplete without a physical exam, which is not possible without a visit to your doctor.